Strokes impact approximately 795,000 Americans each year. Of these, 30% may involve the large vessels, the middle cerebral arteries, the basilar artery, and the carotid arteries. Only 10% of these patients receive definitive early diagnosis and therapy A stroke occurs when a vessel in the brain ruptures or is blocked by a blood clot. Although progress has been made in reducing stroke mortality, it is the fourth leading cause of death in the United States. Moreover, stroke is the leading cause of disability in the United States and the rest of the world. In fact, 20% of survivors still require institutional care after 3 months and 15% to 30% experience permanent disability. This life-changing event affects the patient's family members and caregivers. With an aging US population, the situation will only become more desperate. More significant disability may be associated with large vessel obstruction and large vessel strokes.
Individuals afflicted with a stroke must receive immediate medical attention or risk suffering long term effects. However, many individuals suffering a stroke do not receive medical attention in time or are not diagnosed with a stroke. In some instances, patients are rushed to the closest hospital, but not the appropriate hospital equipped for treating a stroke patient. A hospital may be inappropriate because of inadequate diagnostic equipment, or lack of immediate access to required diagnostic and imaging testing. Also, the hospital may lack medical professionals, such as neurologists or interventional vascular specialists who are trained to give expert interpretation and necessary and warranted therapies. By the time the patient is diagnosed with a stroke, it may be discovered that the patient is at the wrong hospital and the potential for long term affects increases. In a stroke, 2 million nerve cells die per minute. Therefore, time is of the essence when diagnosing and treating stroke patients. It is best to start treatment within an hour of stroke onset.
However, definitive stroke treatment using, for example, clot buster therapy or brain or neck vessel clot removal or clot bypass can be initiated with stroke reversal or reduction in severity and morbidity and elimination of mortality. A golden hour from stroke onset to therapy in selected strokes, particularly those involving the large vessels is recommended, but blood thinner therapy up until 4.5 hours and clot removal up until 6-8 hours but with diminished efficacy of the treatment after the first hour. Early diagnosis and therapy is particularly important for stroke involving the large vessels of the brain and neck (i.e., large vessel obstructions) and only 10% of eligible patients receive definitive therapy. These strokes have the highest potential for significant morbidity and mortality. Adverse factors may affect stroke care. In some instances, definitive therapy may not be available because the stroke has already occurred or is too large and cannot be reversed.
Despite national protocols for stroke care with improved prognosis, the process and logistics of patient care from time of onset (T1) of Stroke or traumatic brain injury (TBI) Episode through initial hospital encounter and emergent and acute care during the acute episode (T ‘n’) in the Emergency Department is inconsistent nationwide. Other inconsistencies with variability and incompleteness nationwide include the capture, collection and communication of pertinent patient data, communication among the entire community of 1st responders and ER physicians/radiologists and staff, and a neurological examination. As such, definitive diagnosis and treatment may not occur on initial presentation at the emergency department. Disorders that are not stroke may not be identified, but still receive potentially dangerous therapy for stroke. Thus, optimal, personalized care is not being done. Hence, there may be delivery of patients to inappropriate sites, unsafe/unwarranted treatment, delayed treatment, inability to treat due to time limitations, increased brain damage, and poorer prognosis.
If the patient arrives late, or is seen outside of the acceptable time window, or the patient has too many other medical risk factors to allow definitive therapy, then these factors may lead to complications, including brain hemorrhage. Also, screening of patients with stroke causing conditions is often not done. This can lead to a stroke, which may be preventable. Traumatic brain injury occurs in 1.7M patients per year, including but not limited to concussion and brain hemorrhage. These may be mild, moderate, or severe. In the context of traumatic brain injury, vascular obstruction, narrowing due to vessel spasm, and vessel tearing of brain and neck vessels place this group of disorders in those needing evaluation as well as those needing attention to their vascular efficacy. The system and methods of the exemplary embodiments described herein will be useful for identification and diagnosis and early therapy for this group of disorders, as well as other brain injuries or other medical conditions.